How long will it take you to get to our office? (1245 Highland Avenue, Suite 404, Abington, PA 19001)

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5.

Have you applied or been screened to be an egg donor before?

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If yes, provide the name and location of the donor program(s).

6.

Are you currently enrolled as an egg donor in another program?

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7.

How many times have you donated your eggs?

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8.

Which ethnicity would you most likely be affiliated?

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9.

Date of Birth (only your calculated age is shared with Recipients)

10.

What is your height?

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11.

What is your weight in pounds?

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12.

What is your highest level of completed education?

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13.

Is your work schedule flexible?

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14.

How many cigarettes do you smoke per day?

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15.

When is the last time you had marijuana?

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16.

How many drinks do you usually consume in a week?

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17.

When is the last time you have used recreational or illicit drugs (cocaine, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinogens, tranquilizers, PCP, steroids for non-medical reasons, or etc.)?

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18.

When was the last time you have had a tattoo or body piercing?

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19.

If a background check were run on you, would it show any problems with the law (i.e. DUI, custody issues, lawsuits)?

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If yes, please explain for your application to be considered.

20.

Have you ever had any arrests, convictions, sentences, etc.?

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If yes, please explainfor your application to be considered.

21.

What is the most number of consecutive days that you have been incarcerated?